By Steve Mitchell

NEW YORK, Mar 28 (Reuters Health) -- Elderly patients who use nonsteroidal anti-inflammatory drugs (NSAIDs) -- a class of drugs that includes aspirin, ibuprofen (Advil), and naproxen (Aleve) -- may be twice as likely to be hospitalized for heart failure as those who do not use NSAIDs, a new report suggests. The study also found that the risk of heart failure increased 10 times in elderly patients who had a history of heart disease and used NSAIDs.

However, the findings do not apply to the low-dose aspirin (100 to 300 milligrams) taken daily by many people to reduce their risk of heart attack. And the study could not conclusively determine that the NSAIDs were indeed the cause of the heart failure.

"My recommendation (to patients) would be to not use these drugs frequently or in high doses," said American Heart Association spokesperson Dr. Gerald Fletcher in an interview with Reuters Health. A high dose might include taking the drugs "3 or 4 times a day," suggested Fletcher, who is with the Mayo Clinic in Jacksonville, Florida. "Smaller doses are probably okay."

Fletcher noted that NSAIDs have many beneficial effects and as long as they are used moderately and infrequently, they "shouldn't be a total no-no." In some cases, acetaminophen (Tylenol), which is not classified as an NSAID, may be an acceptable substitute, he added.

In the study, Drs. David Henry and John Page, both of The University of Newcastle in Australia, compared 365 patients (average age 76 years) who were admitted to hospitals for congestive heart failure with 658 hospital patients without heart failure.

The investigators found that patients who used NSAIDs in the previous week were twice as likely to be hospitalized for heart failure as those who did not. For patients with a history of heart disease who used NSAIDs, the risk of a first admission for heart failure was more than 6 times that of elderly patients without a history of heart disease.

Henry and Page also found that the more NSAIDs the patient had taken the previous week, the more likely it was that they would be hospitalized. If the NSAIDs did indeed cause the heart failure -- which could not be confirmed by this type of study -- about 19% of the hospital admissions for heart failure in this group might be attributed to use of NSAIDs, the researchers estimate.

"Guidelines should discourage the use of NSAIDs in individuals with (heart problems)," the authors conclude in the report in the March 27th issue of Archives of Internal Medicine. They recommend that NSAIDs "should be used with caution in such individuals, in the lowest possible dose."

The advantage of using the lowest dose of NSAIDs is that they are quickly broken down by the body and "if (NSAIDs) are eliminated quickly from the body, they probably allow the kidneys and cardiovascular system to recover before the next dose is taken," Henry said in an interview with Reuters Health.

The authors suggest that the new "superaspirin" painkillers -- a class of drugs known as COX-2 inhibitors, that are available by prescription only -- may be less likely to cause heart failure in elderly patients, but they note that the hypothesis remains to be proven with scientific studies.

Henry told Reuters Health, "There is a belief that (COX-2 inhibitors) will have less deleterious effects on the circulation but may not spare the kidneys. So we will have to wait and see -- they shouldn't be assumed to be a lot safer at the present time."

SOURCE: Archives of Internal Medicine 2000;160:777-784.

http://www.doctorbob.com/ - 03/31/2000